Last Friday we ran the blood work again.
The ALT remains unchanged. It didn't get higher, it didn't get back down to normal. Cookie remains to look happy and healthy. So now what?
Because of the prior elevation, they included a liver profile in addition to comprehensive blood work to check liver function.
Other than the ALT everything else looks normal.
- It is possible that this is normal level for Cookie
- It is possible that it is caused by something outside the liver, such as low grade duodenal or pancreatic inflammation (Cookie did have pancreatitis a bit over a year ago)
- It could be portal vein hypoplasia (PHV) which means that the blood vessels in the liver are reduced in number, resulting in reduced blood flow to the liver
- It could be primary low grade hepatitis, which is inflammation of the liver. If that was the case we'd have to figure out why.
- Liver ultrasound with biopsy to observe vasculature (PVH) and rule out primary hepatitis
- Treating empirically with 4 weeks metronidazole and retest
- GI function test (cobalamin, cPLI, folate)
- Monitoring and retesting annually (which is something we do anyway)
Because the liver could be affected by something such as low-grade chronic pancreatitis, testing the GI function makes sense to me to either discover the culprit or rule it out.
We also had Jasmine's vet review the results.
He feels that unless there are any signs of illness that at this level of the ALT he would not explore further other than regular re-tests. He also feels that it is possible that this level is normal for Cookie. No other values point to an unhappy liver.
A side note:
The earlier blood work also showed elevated eosinophils, a type of white blood cells. Both Cookie and JD had the same elevation. The primary suspect were parasites, even though none showed in the stool. We treated with Panacur and Cookie's eosinophils are back to normal.
There is a possibility that this is behind the ALT elevation and didn't have time to resolve.
I have to say that I don't like it when the blood work shows an abnormality.
Though it is not all that unusual that on a full blood panel a test value might end up outside the normal range. It happened on Jasmine's blood work a number of times that one value or another was off.
But that's just it. In Jasmine's case, it was a different value every time. This one popped up twice consistently.
I think that testing the GI function makes sense to me.
Ultrasound, while non-invasive, requires shaving of the belly. In the temperatures we've been having, running around with a bare belly doesn't sound like a good plan. And putting a sweater on Cookie? The way she runs through the bush it would probably last five minutes if that long.
Putting Cookie through invasive diagnostics while she doesn't seem to be sick at all doesn't make much sense. Or does it?
What would you do?
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